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SAN JC ?UIN COUNTY PUBLIC HEALTH RVICES <br /> NPIVIRONMENTAL HEALTH DIVISlti/ <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4 , Section 2646 (j ) <br /> Facility Name pp�� -4 <br /> Address � dy ( � f /17C ; Y City <br /> FI )( I All inventory variations for the above mentioned facility were <br /> � within allowable limits of Title 23 , California Code of Regulations, <br /> Div.')sion 31 Chapter 16 Section fS4,61 for the 12 month period from <br /> 19]2�5 to 4 <br /> ❑ Inventory variations in excess of the allowable limits of section <br /> 2646, occurred as listed below. <br /> DATE I TANK / PRODUCT AMOUNT (Gallons) <br /> I <br /> Submit report within 15 days following the end of the last month of the <br /> 12-month period covered by the report. Report to be submitted to: <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388 <br /> STOCKTON, CA 95201-0388 <br /> I certify and penal of perjury, that all variations (if any) <br /> exceeding owable lim is are indicated above (California Health & <br /> Safety C ction 2 99) : <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />